Aetna, the insurance arm of CVS Health, is discontinuing roughly 90 Medicare Advantage plans across 34 states for contract year 2026. The decision forces an unknown number of enrolled beneficiaries to shop for replacement coverage before the annual open enrollment window that runs from October 15 through December 7. The exits come as federal payment rates and tightened quality rules squeeze margins for insurers that cannot offset rising medical costs with higher government reimbursements.
Federal payment pressure behind Aetna’s 2026 Medicare Advantage exits
The plan discontinuations trace directly to two federal actions. First, the Centers for Medicare and Medicaid Services finalized a wide-ranging regulation for Medicare Advantage sponsors, known formally as the contract year 2026 policy and technical changes rule. In that final rule, CMS updates payment methodologies, star-rating thresholds, and operational requirements for all Medicare Advantage and Part D contracts. Among other provisions, the agency refines how risk scores are calculated, tightens guardrails around supplemental benefits, and raises the performance bar for plans to maintain or improve their star ratings.
Second, CMS released its annual set of county benchmarks and supporting files that govern how much Medicare Advantage organizations are paid per enrollee. Those benchmarks, available in the agency’s ratebooks, translate into the revenue that plans use to finance medical claims, administrative costs, and extra benefits. For 2026, the rate updates are generally modest, and in some counties they lag the pace of medical-cost inflation. While the public data do not explicitly tie Aetna’s withdrawals to specific counties, the pattern of exits is consistent with a strategy of pruning products in areas where projected margins are too thin under the new payment and quality framework.
CVS Health’s Form 10-K for the fiscal year ended December 31, 2025, filed with the U.S. Securities and Exchange Commission, underscores that dynamic. In the Medicare discussion, the company cites pressure from medical-cost trends, star-rating performance, and evolving regulatory requirements as key factors shaping its portfolio. The filing notes that management “continuously evaluates” product offerings in light of reimbursement and rule changes. That language points to a multi-year repositioning rather than a sudden retreat and helps explain why the 2026 pullback spans dozens of states and roughly 90 distinct plan benefit packages.
What the CMS crosswalk file and non-renewal notices reveal
The most detailed public record of which Medicare Advantage plans survive, merge, or disappear each year is the Part C and D plan crosswalk maintained by CMS. In the 2026 crosswalk, each contract and plan benefit package from 2025 is mapped to its 2026 status, indicating whether it continues unchanged, is consolidated into another plan, or is terminated with no successor. The roughly 90 Aetna plans that will not be offered for 2026 appear in this dataset as terminations or consolidations. However, the file does not break out how many people are enrolled in each discontinued plan, leaving the total number of affected beneficiaries unclear.
For members, the first concrete signal that their coverage is ending arrives in the mail. Beneficiaries enrolled in a discontinued plan receive a standardized non-renewal reminder notice from CMS explaining that their current plan will no longer participate in Medicare for the upcoming year. That letter outlines key dates, emphasizes that coverage continues through December 31 of the current year, and urges recipients to review alternative options. It also directs people to compare plans using the official Medicare Plan Finder tool, call 1‑800‑MEDICARE, or seek one-on-one counseling through State Health Insurance Assistance Programs.
When a Medicare Advantage plan is terminated without a designated successor, enrollees generally must make an active choice during the annual enrollment period if they want to remain in Medicare Advantage. If they do nothing, they are typically returned to Original Medicare for the new plan year, often without prescription drug coverage unless they separately enroll in a Part D plan. In contrast, if a plan is consolidated into another Aetna product, members may be “crosswalked” to that receiving plan automatically, with a chance to opt out if the new benefits or provider network do not meet their needs.
Because Aetna’s 2026 changes combine outright terminations with consolidations, the member experience will vary by county and product. Some beneficiaries will see their current plan’s name and ID disappear but find that they have been moved into a similar Aetna plan with adjusted premiums, copays, or supplemental benefits. Others will face a true loss of their only local Aetna Medicare Advantage option and may need to look at competitors’ plans or return to Original Medicare. In both scenarios, the onus is on beneficiaries to carefully compare premiums, out-of-pocket limits, drug formularies, and provider networks before the December 7 deadline.
For policymakers and market observers, Aetna’s withdrawals highlight how sensitive Medicare Advantage participation is to incremental shifts in payment and regulation. Modest benchmark increases, combined with stricter quality expectations and rising medical costs, can render marginal plans uneconomic, especially in counties with lower benchmarks or volatile utilization patterns. While large insurers can reconfigure their portfolios, the result on the ground is a patchwork of gains and losses in plan choice. The 2026 crosswalk and ratebooks will be closely watched to see whether other carriers follow Aetna’s lead in trimming unprofitable offerings or whether competitors move in to fill the gaps left behind.
